Cluster headache is a very rare form of headache accounting approximately 0.1% of population. But the symptoms of cluster headache are very severe such as excruciating retro orbital pain, which is explosive in nature. The typical feature of cluster headache is periodicity, occurring for 1-2 months (with one or two bouts of attack of excruciating retro orbital pain) once a year. The excruciating retro orbital pain becomes severe very fast and need to be treated with fast acting drugs for control of headache.

An important aspect of therapy to be kept in mind for cluster headache is the rapidity at which the pain peaks, which makes the use of fast acting drugs a must and fortunately the drugs acts very well and give satisfactory result in most of the patients with cluster headache. General treatment measures such as use of 100% pure oxygen at high flow rate of 10-12 liters per minute for at least 15-20 minutes should be given in treatment of cluster headache. It is important to maintain high flow rate and purity of oxygen in treatment of cluster headache.

Drugs used in treatment of cluster headache:

Sumatriptan, a fats acting drug at the dose of 6 mg subcutaneously can shorten the duration of attack of cluster headache to less than 15 minutes. Sumatriptan should be given subcutaneously as it is not effective orally for treatment of cluster headache. Sumatriptan is also equally effective (as effective as subcutaneously) as nasal spray in treatment of cluster headache. Sumatriptan is a very good drug in treatment of cluster headache, as it does not develop tolerance (and can be used for prolonged duration without reduction if effectiveness) and is very effective in shortening the duration of attacks of cluster headache.

Other drugs such as zolmitriptan nasal spay at the dose of 5 mg is also as effective as Sumatriptan and can be used to shorten duration of cluster headache.

Neuro-stimulation therapy in cluster headache:

The neuro-stimulation therapy is an alternative to drug therapy in treatment of cluster headache, when drug therapy fails to give satisfactory result. In neuro-stimulation therapy, stimulation of posterior hypothalamic gray matter deep inside brain, may give satisfactory result in many patients of cluster headache, who do not respond to drug therapy with sumatriptan or zolmitriptan, the most commonly used drugs in treatment of cluster headache.

Another neuro-stimulation therapy is occipital nerve stimulation, which is less invasive, in compare to stimulation of posterior hypothalamic gray matter and can give good result.